Every medical care facility currently has a paper-based manual or semi-automated system for ordering, calling for an administration of, and creating a record of, medications and treatments given to patients or residents. For example, a long term care facility may consist of resident rooms organized in a number of wings. Each wing may have 10-15 resident rooms with 20-30 residents and one nurses' station. The nurses' station is the administrative center for the wing and is the location where care givers perform paperwork, communicate with physicians, a pharmacy and any other entity required for care of residents in the wing. In such an exemplary facility, a physician makes rounds and creates or changes medication and/or treatment orders for the residents. A nurse may call or fax these orders to the pharmacy and also write the order information on the existing paper charts supplied by the pharmacy the previous month. The pharmacy enters all orders into a pharmacy management system. The pharmacy then prepares associated medications for shipment to the facility. The facility receives medication orders from the pharmacy one or more times per day. The nurse checks the delivery contents and signs the packing list and then, places the orders into appropriate cart drawers with other products. As a service to the facility, the pharmacy prints all orders to be performed on the resident on charts for documentation by the care giver. Throughout the month, the facility submits new orders, discontinues or changes existing orders for entry into the pharmacy computer system and documents these orders in writing on the current month's charts.
Near the end of the month, the pharmacy prints all orders on a series of charts for subsequent documentation. Medication orders appear on a Medication Administration Record (MAR), treatment orders appear on a Treatment Administration Order (TAR) and the combination of medications, treatments and other orders appear on a Physician Order Sheet (POS) which is a master record of resident orders. The pharmacy prints the charts for delivery to the facility for the next month's resident charting. When the facility receives the charts, they compare the newly printed charts to the current month's charts to ensure that the pharmacy received all orders and entered all orders accurately. This tedious process of checking and editing as required may take up to 40 hours per month to complete for an average size facility.
A medication pass is a regularly scheduled activity, which occurs during an interval of time, where medications, treatments and other orders are administered or given to a patient or resident. There are usually four scheduled medication passes per day, for example, in the morning, at noon, in the evening and at night. On each scheduled pass, the nurse reviews a MAR on a cart containing all products for a particular resident to determine which activities or events need to be performed or given during the medication pass. Each order may also contain accompanying vital signs orders alerting the nurse that a vital sign must be taken along with the medication administration. The nurse then prepares the medications, enters the resident room, gives the medications to the resident, and then initials and writes the date and pass time on the MAR. If the resident did not take the medication for some reason, the nurse notes the reason on the chart. If a resident requires an “as needed” medication, the nurse administers it and follow the same charting procedure as the scheduled medication. A treatment pass is similar to a medication pass. At certain times during a day, a nurse may administer treatments, for example, bandage changes, applying ointments, etc. The nurse also initials and charts treatments on a TAR that is a separate record from the MAR in the patient's chart.
The above systems are helpful in preventing errors in the administration of medications and treatments, but are dependent on human paper record keeping activities that, by nature, are not error free. Thus, on occasion, errors do occur in the ordering, dispensing and administration of medications and treatments; and errors further occur in the creation of records associated with those processes.
While automating the above systems may seem simply a matter of following the instructions on an order, such systems are very complex and difficult to automate. For example, when an order is created, it is assigned a rate of reoccurrence based either on the number of administrations within a time period, for example, take three times a day, or at a periodic rate, for example, take every 8 hours. Also, the order will have some prescribed duration, for example, a day, 10 days, 90 days, etc. An automated system may predict or pre-calculate medication or treatment administration schedules over some standard window, for example, 30 days or 100 administrations. The pre-calculated values are stored or printed and serve as a “gold standard” for when the medication or treatment should be administered. In other known systems, the precalculation of a future administration may be made in response to charting an administration of a medication immediately preceding the future administration.
However, the calculation of when a medication or treatment is to be administered is based on many factors; and further many of these factors are likely to change over time. For example, a patient or resident may be moved from one wing of a facility that administers a morning medication at 8 AM to another wing that administers the medication at an earlier or later time. Further, those times may change on a daily basis depending on availability of staff and other factors. When those times change, the pre-calculations of administrations are no longer accurate; and they will either remain inaccurate or will need to be recalculated, for example, mentally by the care giver, who is familiar with the changes.
Under other circumstances, some of the factors required for a pre-calculation cannot be known when the order is created. For example, an order for a pain assessment after an order for “pain medication, as needed” is only required if the pain medication was, in fact, given. Thus, any pre-calculation of administrations of medications and treatments will often be erroneous by the time a medication or treatment is due to be administered.
Further, a pre-calculation of administration of medications and treatments may be based on an iterative series of calculations. In other words, in order to calculate a current administration accurately, an immediately preceding administration has to be calculated accurately. Thus, as the calculations move further along in the series over the administration duration, all intervening administrations must be calculated first and calculated accurately. Further, the rules for calculating a generally iterative series may be complex and therefore, cannot be run on an “as needed” basis using the current information. Thus, there is a tension between the need to recalculate often to increase the accuracy of the predicted administration schedules while at the same time not calculating so often that the system becomes bogged down. The end result is that such a system only meets the goals of accuracy, flexibility, and performance in a limited and compromised fashion.
Thus, there is a need for a system that does not have the disadvantages and faults of the known systems described above.